And that’s without reducing fraud and without any fundamental reform. They almost make it sound easy. All numbers refer to the next 10 years:

Gradually raising the premiums that beneficiaries pay for physician and other outpatient services to cover 35 percent of the programs’ costs [instead of 25%], while imposing no additional burden on the poorest 18 percent of seniors: $241.2 billion.

Many of these ideas sound interesting — especially for seniors currently enrolled in Medicare. I have another idea the NCPA has written about in the past [See A Framework for Medicare Reform].

How about Medicare imposing, say, a $5,000 deductible on future enrollees — all those currently under a certain age. Working-age adults would begin to deposit a percent of payroll — maybe 4 percent — into an account controlled by each senior once they turn 65. These funds would be used to pay for medical care below the deductible. This isn’t really draconian. Seniors already pay nearly $5,000 combined in Medigap premiums, Medicare Part D premiums and in cost-sharing.

I am virtually positive that the author of this post has his tongue planted firmly in his cheek but sadly the commenters are taking this seriously. The Democratic party solution to Medicare reform is — drumroll, please — to raise premiums, deductibles and co-pays and reduce benefits. You’d almost think the Democrats were a blood-sucking insurance company.

(The one change that should be firmly opposed at all costs is the Medigap first-dollar coverage change. Only in the Obamaworld would the government force people under 65 to buy healthcare insurance in the private market that they don’t want while forbidding people over 65 from buying healthcare insurance in the private market that they do want.)

These proposals are all cribbed from other sources, even President Obama. Although they do not comprise fundamental reform, as prices are still administered, they are a step forward.

With respect to competitive bidding, I urge caution, because not all medical devices are commodities. Competing products have different features that doctors and patients value, but central planners cannot. The fiscal benefits of competitive bidding accrue to the government, not doctors or patients. It’s as if the government decided that the best way to lower the price of cars was to have the US DOT run a competitive auction to determine the sole supplier of automobiles to the people.

I think the best lever here is the proposal to reduce Medicare’s covering patients’ bad debts to hospitals. The February 2012 “doc fix” was somewhat paid for by reducing this coverage from 100% to 65% by 2015. If we are ever going to achieve patient-centered reform, hospitals will have to become more adept at determining the credit-worthiness of patients and how and when to collect. Reducing Medicare’s coverage of bad debts is a good way towards this.

No need to scrape together $20,000 because private insurance for catastrophic only illness would cover hospitalization. To be sure, some people would not have such insurance.

Nevertheless, I think we might disagree on how to get the hospitals to care for these people. Let’s remember how these hospitals started: They were mostly founded in the 19th century as non-profits with religious affiliations. The leading Catholics or Episcopalians or Jews or whoever in a community sponsored the construction and operation of a hospital.

Indeed, hospitals’ fundraising from philanthropists is huge today. And yet we have more and more government in the mix, leading the hospitals to be bloated and overly expensive.

With respect to the fire department: Leaving aside libertarian arguments for private fire departments, the fire department puts out your fire in order to ensure it does not jump to other buildings in your community. It does not rebuild your house or reimburse you for lost furniture and effects. That is what private insurance and private contractors do.